The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

OBJECTIVE: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. METHODS: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. RESULTS: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. CONCLUSION: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Correction to: The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

[This corrects the article DOI: 10.1007/s40200-018-0358-2.].

Primary leiomyosarcoma in preserved ovary after unilateral oophorectomy.

A very rare case of ovarian tumor is presented. Pathology in the preserved ovary, after unilateral oophorectomy, is briefly discussed.

[Clinical aspects of hyperthyroidism in aged patients]. / Aspetti clinici dell'ipertiroidismo nel soggetto anziano.

Hyperthyroidism is difficult to diagnose in the elderly because at this age thyroid disorders are often insidious and atypical with non-specific symptoms. The diagnosis of thyroid disease may be particularly difficult in the presence of a multiple age-associated pathology which may mask the signs or symptoms of thyroid disease. The paper presents the clinical findings in 18 patients in whom the diagnosis of thyrotoxicosis was established at the age of 65 or later.

[Special obstetrico-gynecologic hospital structure and local service units. Considerations on the availability and need for ULS 35 and 36]. / Struttura specialistica ospedaliera ostetrico-ginecologica e unità locale dei servizi. Considerazioni sulle disponibilità e necessità delle U.L.S. 35 e 36.

The underlying principles of the national health reform measures and those approved by the Piedmont Region's programmes with regard to social and health reorganisation are recalled. Reference is made to anomalies with respect to local health services No. 35 and No. 36 in the case of obstetrics and gynaecology, there being three maternity departments for 97,251 inhabitants in the area concerned. The main aspects of the division are examined. It is shown that implementation will only be possible if there is a usership capable of feeding every branch of the structure set up. It is suggested that the specialist activities of obstetrics and gynaecology be concentrated at Susa and Avigliana, though oven this division will not ensure a proper flow of users. The position could be improved by better employment of the basic structures, i.e. the consulting surgeries and SAUB out-patient departments.

[Hypoglycemia caused by partial deficiency of growth hormone. Description of a clinical case]. / Ipoglicemia da deficit parziale di GH. Descrizione di un caso clinico.

A clinical case of a female patient suffering from recurrent, especially nighttime, attacks of hypoglycaemia is reported. Clinical tests found these to be the consequence of partial hypophyseal deficiency of growth hormone.

[Changes in feeding behavior in anorexic individuals. Description of 2 clinical cases]. / Alterazione del comportamento alimentare in individui anoressici. Descrizione di due casi clinici.

The change in the eating behaviour of anorexic individuals has been studied with particular attention to the case of two biovular heterozygotic twins. It is observed that dietetic treatment backed by careful psychiatric therapy is a decisive factor in the resolution of the pathology.

[Hymenolepis diminuta: a rare helminthiasis in humans. Description of a clinical case]. / Hymenolepis diminuta: un'elmintiasi rara nell'uomo. Descrizione di un caso clinico.

The paper describes a case of hymenolepis diminuta, a relatively uncommon helminthiasis in man. The patient examined displayed very particular aspects with regard to the course of the disease and its diagnosis.

[Type I diabetes mellitus and autoimmunity. Description of 9 clinical cases]. / Diabete I ed autoimmunità. Descrizione di 9 casi clinici.

Diabetes mellitus type I can ben divided into two forms, IA and IB, with partially different clinical and pathogenetic characteristics. The present paper looks at type I diabetic patients presenting associated pathologies of autoimmune type, largely involving the endocrine system.

[Analysis of the results and considerations on the organizational aspects of the implementation of the Law 194/78 in a provincial hospital]. / Analisi dei risultati, considerazioni di ordine organizzativo circa la legge 194/78 applicata in un Ente Ospedaliero di provincia.

PIP: Law number 94 legalizing abortion passed in Italy in May 1978. This article reports on the situation of induced abortion in the small provincial hospital of Avigliana, Torino, 1 year after the implementation of the law. The paramedical personnel were supportive of the medical and obstetrical personnel who, not being conscientious objectors, accepted to perform abortions. Every woman was thoroughly checked and counseled prior to the operation by the same doctor who was going to perform the abortion; the procedure was always done under general anesthesia and by vacuum aspiration. There were 66 abortions between June-December 1978, and 115 between January-July 1979. Contrary to expectations the number of deliveries also increased, from 66 during the 1st half to 145 during the 2nd half of operations. More than half the number of patients were referred from the ambulatory clinic within the same hospital, as compared to only 25% during the 1st half; only 7.8% were referred by private physicians, as compared to 30% during the 1st half. Almost 50% of patients were housewives both during the 1st and during the 2nd half; age of patients was, for the great majority, between 24-35; parity was 2 in 43.8% of cases for the 1st half, and in 40% of cases in the 2nd half. The majority of operations was performed within the 1st 8 weeks of pregnancy, and many women came from districts outside that of Avigliana. 34.8% of requests for abortion were because of failure of contraception, and almost 40% for socioeconomic reasons; only 8.2% of requests were motivated by reasons of health. Misinformation about contraceptive practices was widespread among the patients.^ieng

Amniotic fluid testosterone and fetal sex determination (discussion of the endocrine function of the fetal testis).

Amniotic fluid testosterone levels were determined by the radioimmunoassay technique in 101 samples obtained by amniocentesis between 16 and 18 weeks of gestation from women with increased risk of chromosomal abnormalities. Fetal sex was determined by cell culture and chromosomal analysis of fetal amniotic cells and was confirmed at birth. In pregnancies with male fetuses (50 samples), the mean amniotic fluid testosterone level of 216 pg/ml (+/- 75) was significantly higher (p less than 0.001) than the mean value of 93 pg/ml (+/- 28) found in pregnancies with female fetuses (51 samples). The range for pregnancies with male fetuses was 130 to 500 pg/ml and for those with female fetuses 10 to 140 pg/ml, showing an area of overlap from 130 to 140 pg/ml.

Blood lactate behavior after glucose load in diabetes mellitus.

The aim of this study was to evaluate the relationships between blood lactate and plasma glucose, insulin (IRI) and C-peptide (IRCP) during the first hour of an oral glucose load (OGTT, 100 g). Twelve controls, sixteen non-insulin-dependent (NIDDM) and four insulin-dependent (IDDM) diabetic subjects were studied. A significant increase in blood lactate was observed at 15 min in normal subjects, whereas there was a delayed increase at 45 min in NIDDM subjects, in the presence of IRCP increments of 0.31 nmol/l. In order to have a minimum significant lactate increment, the threshold value of peripheral IRCP increment was about 0.30 nmol/l. In IDDM subjects, despite considerable hyperglycemia, blood lactate concentration remained unchanged throughout the test. In normal and NIDDM subjects there was a significant negative correlation between delta lactate and delta glucose (r = -0.89, p less than 0.001) and a significant positive correlation between delta lactate and delta IRCP (r = 0.78, p less than 0.001). In conclusion, hyperglycemia itself and the lack of increase in insulin secretion do not affect blood lactate increase during OGTT; blood concentration of this metabolite depends mainly on an early insulin secretion apt to enhance tissue glucose uptake and to inhibit gluconeogenesis.

Correlations between glycosylated haemoglobin and other metabolic parameters in insulin-dependent diabetics.

The metabolic parameters of 40 insulin-dependent patients (22 females and 18 males) have been studied to evaluate their intercorrelations. We obtained positive correlation between glycosylated haemoglobin and triglycerides (r = +0,460; p less than 0,01) and between HbA1 and mean diurnal plasma glucose (MDPG) (r = +0,652; p less than 0,001). There was a negative correlation between HbA1 and high density lipoproteins (HDL) cholesterol (r = -0,406; p less than 0,05). No significant correlation was found between HbA1 and either uric acid or total cholesterol. Correlations were also found between MDPG and triglycerides, MDPG and HDL-cholesterol, triglycides and HDL-cholesterol, uric acid and HDL-cholesterol. These correlations are discussed.